Monday, January 27

Melasma in men

Melasma in men
Melasma is an acquired hypermelanosis affecting both men and women of Hispanic and Asian origin. Melasma is predominantly a female problem and only 10% of the affected individuals are men.
The localized hyperpigmentation is light to dark brown color. In chronic and deep-seated cases the lesions may appear grayish brown. Melasma in men is found to occur commonly on the face and sometimes also on the arms and neck.

The clinico-histological patterns and characteristics of melasma in men appear very similar to those of the lesions affecting women. Genetic susceptibility and environmental triggers are similar in both the genders. However the endocrine and hormonal factors, especially female hormones, do not seem to play a significant role in men, perhaps being subtle.

Shaving and the use of soap, after-shave, lotions, perfumes and facial sprays are important triggering factors in susceptible individuals. Three localized patterns of the hyperpigmentation are observed. They are centrofacial, malar, and mandibular hypermelanosis. Centrofacial pattern is present on the forehead, cheeks, nose and upper lips. Malar pattern is seen on the cheeks and nose. Mandibular pattern is present on the jawline. Examination of the lesions with ultraviolet light from Wood's lamp reveal that these lesions have epidermal, dermal or mixed location/origin.

The clinical, aetiological and histological study undertaken by R.Sarkar et al of Department of Dermatology, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, India on melasma in men has thrown light on the causative factors. When statistically compared with women, sun-exposure and family history are the predominant factors causing melasma in men. The clinicohistopathological characteristics are similar to those in women. Though more common in women, melasma is more frequently (20.5%) observed in Indian men when compared with global scenario.

Compared with healthy persons, 'Dermatology Life Quality Index' (DLQI) scores in melasma affected have been found to be high, indicating a poor quality of life (QOL). A study by R.Pichardo et al concluded that "melasma is a common condition in Latino men associated with quality of life".

There are several options available for the . The foremost is the sun protection. Reducing exposure to direct sunlight is necessary. The American Academy of Dermatology (AAD) recommends use of sunscreen with SPF 30+ to protect from both ultraviolet A and ultraviolet B radiations. For more information read the post 'melasma treatment'.

The use of skin lightening agents like tretinoin, hydroquinone, azelaic acid, glycolic acid, kojic acid, corticosteroids and formulations combining two or more of these agents is effective. Kligman's triple combination formula of 2% hydroquinone, 0.025% tretinoin, and 1% steroids (mometasone) has been proved to be the most effective in resolving melasma, especially epidermal lesions. Chemical peels, laser therapy and dermabrasion show limited success.

1.Vachiramon V, Suchonwanit P, Thadanipon K. Melasma in men. J Cosmet Dermatol. 2012 Jun;11(2):151-7.
2.Vázquez M, Maldonado H, Benmamán C, Sánchez JL. Melasma in men. A clinical and histologic study. Int J Dermatol. 1988 Jan-Feb;27(1):25-7.
3.Sarkar R, Puri P, Jain RK, Singh A, Desai A. Melasma in men: a clinical, aetiological and histological study. Journal of the European Academy of Dermatology and Venereology. 2010 Jul;24(7):768-72.
4.Rita Pichardo, Quirina Vallejos, Steven R. Feldman, Mark R. Schulz, Amit Verma, Sara A. Quandt, and Thomas A. Arcury. The Prevalence of Melasma and Its Association with Quality of Life among Adult Male Migrant Latino Workers. Int J Dermatol. 2009 January; 48(1): 22–26.
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Friday, January 17

Melasma hyperpigmentation - Melasma causes and symptoms

Melasma signs, symptoms and causes
Melasma (aka chloasma or the mask of pregnancy) is hyperpigmentation of skin caused by the excess deposition of melanin pigments. Symptoms of melasma discolorations appear as irregular light brown to dark brown patches.
Exposure to sun causes the lesions to spread and darken.
Melasma is found to develop in women in their 20 to 50 years of age.
It is rarely seen in men and only 10% of the melasma cases are seen in men.
Pregnant women, those taking oral contraceptives or undergoing hormone replacement therapy (HRT) are likely candidates for developing melasma hyperpigmentation.
The facial hyperpigmentosis is a very disturbing cosmetic problem and causes considerable emotional and psychological impacts.

Melasma appears to be a familial condition as it is found to run in families. People with light brown, olive and yellow skin color have higher rate of melasma incidence. In the summer months the hyperpigmentation is found to intensify and spread and in the winter months the lesions lighten and fade.
Picture of melasma hyperpigmentation on the face
picture of melasma on face
Image by Elord | CC BY-SA 3.0

Signs and symptoms of melasma

The appearance of light brown lesions is the early symptom of this hyperpigmentation.
The older lesions may appear grayish brown in color.
The patches are irregularly shaped and have well-defined margins.
Another symptom is that the hyperpigmentation tend to darken on sun exposure.
The lesions usually appear on the face and develop on the forehead, cheeks, chin, upper lip and sides of the nose.
Another typical symptom is that the lesions are symmetrical, affecting both the sides of the face.

What causes melasma?

The exact cause of the development of melasma hyperpigmentation is complex and is not clear. Complex factors interrelated to genetic predisposition, female hormones (estrogen and progesterone) and UV radiation appear to cause the lesions. The endogenous factors which trigger the lesions include female hormones and genetic predisposition.

The exogenous factors which trigger this hyperpigmentation include sun exposure, hormonal medications, cosmetic preparations and post inflammatory hyperpigmentation. However in men hormonal factor is not relevant and the etiological factors appear to be sun-exposure, family history, use of cosmetic preparations and chronic inflammatory illness.

Apart from the excess production of , these etiological factors contribute an increase in the number of melanocytes (melanin producing cells). There may be proliferation and dilation of capillaries in the dermis. In chronic cases bluish-grayish-brown hyperpigmentation is due to the skin pigments slipping into the dermis.

Anomalies in the functioning of the pituitary gland may cause hyperpituitarism (hypersecretion of pituitary hormones). Hypersecretion of melanocyte–stimulating hormones (MSHs) by the pituitary gland is also believed to cause the hyperpigmentation.

Etiological causes

  • genetic predisposition
  • pregnancy
  • menopause
  • increased estrogen, progesterone secretion by the body
  • hormone replacement therapy (HRT)
  • ovarian disorders
  • hormonal imbalance can cause melasma
  • increase in melanocyte-stimulating hormone (MSH)
  • oral contraceptives
  • sun exposure and the use of sunbeds
  • cosmetics
  • perfumes
  • toiletries
  • phototoxic reactions
  • certain medications
These hyperpigmentation lesions can treated but their recurrence is always possible. Avoiding the triggering causes can help in controlling and resolving the melasma patches.

Popular topics in natural skin care:
Skin pigmentation on face.
Hyperpigmentation on face.
Hypopigmentation on face.
1.Vaneeta M. Sheth, Amit G. Pandya. Melasma: A comprehensive update Part I & II. Journal of the American Academy of Dermatology Volume 65, Issue 4, October 2011. Picture source: Picture author: Elord from Wikidocs | License: CC BY-SA 3.0

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Wednesday, January 15

What is melasma? - Definition of melasma

What is melasma and its definition

What is melasma?

Melasma is a hyperpigmentation of the skin, particularly common in women.
Often pregnant women are affected by melasma and it is also known as chloasma or the mask of pregnancy. Genetic predisposition is one of the triggering factors in the development of melasma.

This brown discoloration of skin is also found to affect women taking oral contraceptives or undergoing hormone replacement therapy (HRT). Though this cosmetic discoloration is observed both in men and women, only 10% men were observed to develop the lesions.

Melasma is rarely encountered in teens and young adults. It may appear in thirties and persist for many years. In post menopause women the brown patches may fade completely. It is believed to be linked with estrogen and progesterone hormones which induce hyperactivity of melanocytes on exposure to sun.

Melasma hyperpigmentation on the face
picture of melasma on face
Image by Elord  |  CC BY-SA 3.0
Excess skin pigment synthesis and also increase in the number of melanocytes are the causes of the hyperpigmentation. In pregnant women the lesions may start resolving after giving birth. Similarly the discontinuance of hormonal treatments can help in the resolution of the lesions.

For prevention and for reducing the lesions avoiding sun exposure and using sunscreens is recommended. In the treatment of the lesions, pigment synthesis blocking agents, skin peels and lasers are being used. There is every possibility of recurrence after the treatment.


"a tan discoloration of a woman's face that is associated with pregnancy or with the use of oral contraceptives."

Medical definition

"sharply demarcated, blotchy, brown macules, usually in a symmetrical distribution on the cheeks and forehead and sometimes the upper lip and neck, often associated with pregnancy or other altered hormonal state."

Encyclopedic definition

"Melasma is a tan or dark skin discoloration."

Picture source:
Picture author: Elord from Wikidocs | License: CC BY-SA 3.0
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Tuesday, January 14

Skin hyperpigmentation

Hyperpigmentation of skin
Hyperpigmentation of skin is a common problem faced by most of us. Skin hyperpigmentation affects women and men equally.
All ethnic groups can develop areas of darkened skin. Though it is more common in middle age and beyond, young individuals may also get affected.

Skin hyperpigmentation may be idiopathic or caused due to sun damage, diseases, acne, inflammation, hormonal imbalances or injuries. All these conditions can lead to excess deposition of melanin pigment and hyperpigmentation or overgrowth of dermal and epidermal tissues.

is determined by the genetic makeup which has evolved over time into different ethnic groups. The skin of these ethnic groups react differently to hyperpigmentation causing stimuli. The skin of very fair individuals may respond to excess sun exposure with sunburn and sun damage whereas the people of Mediterranean, Asian or African origins develops skin hyperpigmentation for similar exposure. However overexposure to ultraviolet radiation can cause skin cancer in both the groups.

Dark brown discoloration of skin

Hyperpigmentation generally leads to dark brown discoloration of skin. The discoloration can be as spots, patches or occur on greater areas of skin. Depending on the type of affecting disorder the discoloration can form on any particular region of the skin or generalized.

The discoloration can form on the face as in the case of acne scars or melasma. Many infections, especially by fungii can lead to brown hyperpigmentation which resolve after treatment of the disease. However in some conditions the dark brown discoloration may last for life.

For more information read ''.

Dermal discoloration pictures

The pictures of dermal hyperpigmentation gives us a clear comparative idea about the medical conditions and help us in differential diagnosis of disorders like, Addison's disease and acanthosis nigricans. Addison disease initially may appear as patchy tanning.

The pictures also help us from differentiating between sunburn and suntan. Freckles are concentrated clusters of melanin deposits whereas lentigines is due to proliferation of of melanocytes. The lentigo has linear spread whereas the mole hyperpigmentation is a multi-layer nest of melanocytes.

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What is Acanthosis nigricans - Definition

Acanthosis nigricans is brown to black, velvety, poorly defined hyperpigmentation. It is usually found in the body folds like groins, armpits, neck folds etc. There are many causative and triggering factors of this hyperpigmentation disorder like obesity, inheritance and hormonal imbalances.

The skin color of the affected area may range from light brown to black. Acanthosis nigricans hyperpigmentation can begin at any age. Papillomatosis (finger-like growths) and skin tags are observed in and around the affected area.

For more information read ''.

Acanthosis nigricans pictures - Causes - Treatment

The causes of developing acanthosis nigricans are many. Obesity, insulin resistance, hormonal imbalances, certain medications, hypothyroidism, pituitary gland disorders, genetic disposition, certain syndromic diseases and cancers are some of the causative factors.

There is no specific treatment for acanthosis nigricans hyperpigmentation. Treating the underlying cause and trigger can bring about the relief and resolution of the disorder. Reducing the sugars or starches in food to bring down the circulating insulin will help a lot.

For more information read ''.

Acne blemishes

Acne is a very common skin problem especially of the teens and young adults. The pores of the hyperactive sebaceous glands get blocked and out come is acne and infection. The blocked pores with the onset infection tend develop inflammation.

The healing process in the acne starts with granulation tissue formation and matrix remodeling. In the new matrix, collagen protein has different fiber composition from that of the original protein leading to scars and hyperpigmentation.

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Acne scars types

Acne scars and hyperpigmentation are brought about by the healing process and the tissue repair mechanism. Depending upon the level of tissue damage and inflammation in the infected acne, hypertrophic or atrophic scars are formed.

In hypertrophic scars there is net increase in the repair tissue resulting in raised thickened tissue. In atrophic scars there is loss of tissue and causing the formation of depressed areas. Depending upon the appearance, atrophic scars are categorized into ice pick, boxcar and rolling scars.

For more information read ''.


Melasma is patchy brown skin hyperpigmentation usually developing on the face. Genetic predisposition and frequent sun exposure seen to precipitate the development of melasma. Mostly women are affected by the lesions and is rare in men.

Pregnant women as well as women taking hormonal medications appear to develop the lesions frequently. The withdrawal of hormones or childbirth appears to resolve the brown hyperpigmentation completely.

For more information read ''.

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Monday, January 13

Acanthosis nigricans - Pictures - Treatment - Causes

Acanthosis nigricans pictures - causes and treatment
Acanthosis nigricans (AN) is a hyperpigmentation disorder (see images) of the skin. Obesity is one of the major causes of acanthosis nigricans.
The treatment of acanthosis nigricans is directed towards the underlying causes for the resolution of the condition.

Acanthosis nigricans signs, symptoms and diagnosis

  • This skin disorder is identifiable by the development of symmetrical, poorly defined, velvety hyperpigmentation of the skin.
  • Usually, intertriginous (folds and crease) areas of skin like underarms, groins, sides of the neck, folds under the breasts and ano-genetal regions are affected.
  • The skin color of the affected area may range from light brown to black.
  • Acanthosis nigricans can begin at any age.
  • Papillomatosis (finger-like growths) and skin tags are observed in and around the affected skin.
  • In acanthosis nigricans, there is hyperkeratosis and hyperplasia of and .
  • There is visible diffused thickening of .
  • In children the benign hereditary AN or insulin resistant AN are often noticed.
  • Occasionally mucocutaneous areas of the body may get affected.
  • Diabetics are often affected by acanthosis nigricans.
  • Individuals of African descent are also often affected.
  • Generalized form covering a greater areas of the skin is seen in very rare cases.
  • A skin biopsy of the affected skin usually shows hyperkeratosis, hyperplasia and papillomatosis.
  • The affected skin may get infected and lesions may appear making the .
    If the symptoms are observed on areas which are not normally affected like palms, soles, lips and mucous membranes, there is the possibility of hidden cancer.

Acanthosis nigricans causes

The causes of developing acanthosis nigricans disorder are many.
The foremost cause is obesity and related endocrine disorders.
Many diabetics have been found to face this problem.
Hypothyroidism, a disorder of thyroid glands, decreases the production thyroid hormone and is one of the causes.
Deficiency of adrenal gland produced hormones is known to cause AN.
Pituitary gland disorders also cause acanthosis nigricans.
The intake of hormonal pills, including oral contraceptives, is known to trigger the lesions.
Gastrointestinal, genital or urinary tract cancers may trigger the condition.
picture of acanthosis nigricans affected back of a child
1.picture of acanthosis nigricans affected back
pictures by Vandana Mehta Rai
and C Balachandran

Types of acanthosis nigricans

The lesions may be benign or associated with malignancy. There are eight types of this disorder.
Obesity-associated type: The most common type induced by obesity and insulin resistance.
Syndromic: Persons suffering from Cushing's syndrome, polycystic ovary syndrome etc have been found to get affected by this disorder.
Acral type: Thick velvety idiopathic growth appears on the upper side of both hands and feet in otherwise healthy individuals. Persons of African descent are more prone to develop this condition.
Drug-induced: Several medicines containing nicotinic acid, insulin, systemic corticosteroids and hormones may induce the benign lesions.
Hereditary: In hereditary acanthosis nigricans, the lesions gradually appear and enlarge. Then they stabilize or regress on their own. As the cause is genetic there is no treatment for hereditary type except applying antibiotics for treatment of infections and applying exfoliating agents primarily to improve cosmetic appearance.
Malignant: This type is associated with the malignancy of gastrointestinal tract and urinogenital system. Lesions may be present in the mouth, tongue and lips. The lesions develop fairly fast when compared to benign types.
Mixed-type: Patients having one type may develop another type when multiple causative factors are present in the individual. For example a patient with drug-induced type may also develop obesity-associated type in case of obesity.
Generalized acanthosis nigricans has been in reported in rare pediatric cases (see pictures).
picture of acanthosis nigricans affected chest of a child
2.picture of acanthosis nigricans affected chest

Treatment of acanthosis nigricans

The first step in the cure of AN is immediate treatment of the underlying cause.
Reducing the sugars or starches in food to bring down the circulating insulin is the first line of treatment for improvement in the .
Treatment for medicine induced disorder is immediate withdrawal of the culprit medicine.
Laser treatment or dermabrasion have been successfully used to reduce the skin thickening in some cases.
Cancer induced acanthosis nigricans may resolve once the tumor is successfully treated or removed.
Vitamin A oral treatment is helpful in reducing the severity of the condition.
Topical exfoliating agents and peels like alpha hydroxyacids, salicylic acid, retinoids, keratolytics and urea are effective as cosmetic treatment of skin thickening.
picture of acanthosis nigricans affected neck of a child
3.picture of acanthosis nigricans affected neck


One very important step in preventing the possible occurrence of benign acanthosis nigricans is the management of weight.
In most of the cases obesity is the cause or at least the triggering factor.
picture of Acanthosis nigricans in underarm with velvet skin texture
4.picture of acanthosis nigricans in armpit
Reducing the sugars or starches to bring down the circulating insulin can stall the development of acanthosis nigricans.
Secondly, control and treatment of hormonal disorders is very important.

1.picture source:
picture authors: Vandana Mehta Rai MD DNB, C Balachandran MD | License: CC BY-SA 3.0
2.picture source: 5.jpg
picture authors: Vandana Mehta Rai MD DNB, C Balachandran MD | License: CC BY-SA 3.0
3.picture source: 3.jpg
picture authors: Vandana Mehta Rai MD DNB, C Balachandran MD | License: CC BY-SA 3.0
4.Picture source:
picture author: Madhero88 | license: CC BY-SA 3.0
1.Vandana Mehta Rai MD DNB, C Balachandran MD. Generalized acanthosis nigricans in childhood. Dermatology Online Journal 12 (6): 14. (with pictures)
2.Habif TP. Cutaneous manifestations of internal disease. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 26.
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Saturday, January 11

What is acanthosis nigricans - Definition of acanthosis nigricans

Meaning of acanthosis nigricans and its definition
What is acanthosis nigricans?
Acanthosis nigricans (AN) is a skin condition characterized by hyperpigmentation. In this dermatological condition, poorly defined symmetrical hyperkeratosis and verrucous plaques develop giving the affected area of the skin a velvety texture.
Usually acanthosis nigricans affects the intertriginous areas of skin like the axilla of the arm, the anogenital region, submammary region, groins and sides of the neck.
In very rare cases the condition may be generalized as seen in the image. Occasionally mucocutaneous areas may get affected.

'Acanthosis' is diffused thickening (hyperplasia) of epidermal skin.
There is increased thickness of stratum basale and stratum spinosum. It is derived from the Greek word "Acanthus" meaning "thorn".
In the advanced condition, verrucous plaques giving spiny appearance may develop.
The word "nigricans", is from the Latin, meaning "becoming black".
Acrochorda (fibroepithelial polyps), small benign tumors, are usually associated with AN. There are benign and malignant forms of acanthosis nigricans. The causes of this disorder include, obesity, endocrine abnormalities and genetic inheritance. Malignant forms may involve mucous membranes and are usually associated with gastrointestinal and genitourinary cancers. Treating the causative factors gradually resolves the condition in most of the cases.
picture of acanthosis nigricans affected back

Acanthosis nigricans definition

"a skin disease characterized by dark wartlike patches in the body folds; can be benign or malignant."
Medical definition
"a skin disease characterized by gray-black warty patches usually situated in the axilla or groin or on elbows or knees and sometimes associated with cancer of abdominal viscera."
Encyclopedic definition
"Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin."

Authors: Vandana Mehta Rai MD DNB, C Balachandran MD | License: CC BY-SA 3.0
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Tuesday, January 7

Skin pigment - Melanin pigment

Melanin pigment in skin

Melanin pigment

Melanin pigment gives color to skin, hair and eyes in humans.
The melanin skin pigment is derived from the amino acid tyrosine.
The melanin pigment is a polymer compound which is neither a protein nor an amino acid.
Apart from mammals many other organisms in the animal kingdom have been found to have this skin pigment.
Apart from its presence in the epidermis, iris and hair, melanin pigment is found in parts of the brain.

When the body is unable to produce the pigment due to certain physiological conditions, disorders like albinism, leucism and vitiligo occur. In certain diseases like tinea versicolor and in certain conditions like idiopathic guttate hypomelanosis, nevus depigmentosis and pityriasis alba there is partial loss of normal melanin pigment showing up as patches of .


Melanocytes are the pigment producing cells. They are present in the stratum basale, the innermost of the five layers of epidermis. The pigment granules are produced by melanocytes in melanosomes which are specialized membrane–bound cellular vesicles.

human skin color variations
Human skin color variations
Melanin synthesis is carried with the help of enzymes present in the melanosomes. There are melanogenic regulators in melanocytes. This pigment is the end product of complex interaction between melanogenic regulators and factors derived from keratinocytes and fibroblasts.

Tyrosinase is an important enzyme in melanogenesis, transforming the tyrosine, the base amino acid. Tyrosinase is important for the synthesis of both eumelanin and pheomelanin.

When the melanosomes are full with the pigment granules, they are transferred to keratinocyte cells in the epidermal layer of skin. Melanosomes usually accumulate atop the nucleus of the keratinocyte cell, protecting it from the sun's radiation and genetic damage.

There is not much difference between the concentration of melanocytes between individuals of different ethnic groups. The variations in the is due to quantity, type, size and pattern of distribution of the pigment. The concentration and the type of pigment contributing to human complexion is determined by the genetic makeup of an individual.

The frequency of expression of the melanin-producing genes is controlled by the genotype of an individual. Melanogenesis is multidirectional in nature. Apart from the genetic makeup, the type and distribution of the pigment in the skin is modulated by environmental and endocrine factors.

Types of melanin pigments

Melanin is made up of smaller component molecules. Different types of melanin arise due to differing proportions and bonding patterns of these components. There are three types of pigments found in the human body. Eumelanin and pheomelanin are found in the epidermis and hair. Neuromelanin is present in the parts of the brain.


Eumelanin, a brown-black polymer of dihydroxyindole carboxylic acids, is the most common skin pigment with black and brown subtypes imparting brown, dark brown and black color. Individuals with darker complexions produce more of the black eumelanin. Small amounts of brown eumelanin in hair with the lack of any other pigment produces blond hair. In grey hair small quantities of black eumelanin is present.


The color variations ranging from red, pink to yellow are imparted by the pheomelanin. Individuals with fair complexions produce more of the pheomelanin. Pheomelanin is concentrated in the lips, nipples and genital parts. Pheomelanin is present in large quantities in red hair.


Neuromelanin pigment is present in the parts of the brain like medulla, the locus coeruleus and the substantia nigra. Neuromelanin is found to effectively ligate metal ions through its carboxylate and phenolic hydroxyl groups and protect the neurons from potentially toxic metal ions. In Parkinson's disease and also in a variety of neurodegenerative diseases, there is loss of neuromelanin, followed by increase in the iron deposits in the brain.

  • Eumelanin gives photoprotection to the epidermis by absorbing/scattering UV radiation in the sunlight.
  • It preserves folic acid from getting destroyed due to ultraviolet-A rays.
  • The ratio of eumelanin to pheomelanin in the epidermis imparts color complexion.
  • The area in the retina called fovea does not develop properly in the absence of the pigment.
  • It is also important for the proper development of nerve connections between the retina and the brain.
  • Tanning is a type of melanin production induced by DNA damage from ultraviolet (UV) radiation.
  • Higher concentration of the pigment limits exposure to sunlight and interferes with vitamin D synthesis by the dermis especially in higher latitudes.
  • Melanin in the iris protects the eyes from glare and radiation.


1.Slominski A, Tobin DJ, Shibahara S, Wortsman J. Melanin pigment in mammalian skin and its hormonal regulation. Physiol Rev. 2004 Oct;84(4):1155-228.
2.Sulaimon SS, Kitchell BE. The biology of melanocytes. Vet Dermatol. 2003 Apr;14(2):57-65.
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